Project description:BackgroundThis paper describes the systematic development of an intervention for the prevention of obesity among overweight adults. Its development was guided by the six steps of Intervention Mapping (IM), in which the establishment of program needs, objectives and methods is followed by development of the intervention and an implementation and evaluation plan.MethodsWeight gain prevention can be achieved by making small changes in dietary intake (DI) or physical activity (PA). The intervention objectives, derived from self-regulation theory, were to establish goal-oriented behaviour. They were translated into a computer-tailored Internet-delivered intervention consisting of four modules. The intervention includes strategies to target the main determinants of self-regulation, such as feedback and action planning.The first module is intended to ensure adults' commitment to preventing weight gain, choosing behaviour change and action initiation. The second and third modules are intended to evaluate behaviour change, and to adapt action and coping plans. The fourth module is intended to maintain self-regulation of body weight without use of the program.The intervention is being evaluated for its efficacy in an RCT, whose protocol is described in this paper. Primary outcomes are weight, waist circumference and skin-fold thickness. Other outcomes are DI, PA, cognitive mediators and self-regulation skills.DiscussionThe IM protocol helped us integrating insights from various theories. The performance objectives and methods were guided by self-regulation theory but empirical evidence with regard to the effectiveness of theoretical methods was limited. Sometimes, feasibility issues made it necessary to deviate from the original, theory-based plans. With this paper, we provide transparency with regard to intervention development and evaluation.Trial registrationNTR1862.
Project description:Because self-management is central to sickle cell disease (SCD) management, this descriptive study of 18 young adults with SCD, ages 19-39, was conducted to understand their pain experience and to identify the specific home activities they use for pain prevention and management prior to care-seeking. Participants completed two baseline surveys and one semi-structured, individual interview. Content analysis of the interview transcripts yielded two themes: difficulty in describing pain and living with pain. Participants used pharmacological and non-pharmacological strategies to alleviate pain and avoid disease complications but report barriers to using these strategies. Healthcare providers should use study findings to provide appropriate care to and improve pain outcomes for young adults with SCD. In addition, interventions aimed at addressing barriers and optimizing self-management are needed.
Project description:Initial COVID-19 lockdown restrictions in the United Kingdom (23rd March-12th May 2020) prompted lifestyle changes for many people. We explored the impact of this lockdown phase on pet dogs using an online survey completed by 6004 dog owners, who provided information including dog management data for the 7 days prior to survey completion (4th-12th May 2020), and for February 2020 (pre-lockdown). We explored associations between potential predictors and four outcomes relating to changes pre-/during lockdown (reduction in number and duration of walks; increased frequency of play/training, and provision of toys). Most owners (79.5%) reported their dog's routine had changed compared to pre-lockdown. There was a four-fold increase in the proportion not left alone for >5 min on any day during a weekly period (14.6% pre-lockdown, 58.0% during lockdown), with the proportion being left for ≥3 h at a time decreasing from 48.5% to 5.4%. Dogs were walked less often and for less time daily during lockdown, with factors related to the dog, owner, household, and home location associated with changes to walking practices. Many dogs had more play/training sessions and were given toys more frequently during lockdown. Decreased walk duration was associated with increased odds of play/training opportunities and toy provision. These changes to dog management have the potential for immediate and longer-term welfare problems.
Project description:BackgroundMany young people have a tendency to be concerned about their physical appearance and undertake practices in order to achieve certain body ideals. There is however limited information from developing countries on the weight perceptions of emerging adults (i.e. individuals leaving the adolescence life stage and preparing to take on adulthood) and whether these opinions influence their nutritional status and weight management practices. This study sought to assess emerging adults' nutritional status, their weight perceptions and the methods they use to manage their weight.MethodsThis study was cross-sectional, involving emerging adults (N = 192) recruited at shopping areas in the Accra Metropolis of Ghana. A pretested questionnaire was used to collect information on demographic characteristics, weight perceptions, and weight management strategies. Anthropometric measurements were taken using standard procedures. Descriptive analysis was performed on the demographic data, methods used to manage weight, and weight perceptions. Logistic regression was used to assess possible relationships between weight perceptions and nutritional status as well as weight perceptions and weight management practices.ResultsThe mean age of participants was 21.8(2.2) years with 51.0% of participants being female. Majority of the participants perceived normal weight status as the ideal body for themselves and half of them thought that they were slimmer than they actually were in reality. Three major weight management strategies were identified: engaging in physical activity, dieting and making lifestyle modifications (i.e. changes in normal eating habits coupled with regular physical activity and behavioral changes). Emerging adults who had an inaccurate body image perception were less likely (OR = 0.30, 95% CI: 0.15-0.61) to have a healthy nutritional status than emerging adults who had an accurate body image perception.ConclusionWeight perception was associated with nutritional status. Discussions with nutrition professionals regarding realistic weight ideals would be beneficial for this age-group since half of the study's participants had inaccurate perceptions about their current weight statuses even though their statuses were normal.
Project description:BackgroundWeight stigma impairs health. Few studies have disentangled the associations of experienced versus internalized stigma with weight-related outcomes.PurposeTo examine weight and health variables associated with weight stigma experiences and internalization in the largest-to-date sample of adults in weight management.MethodsWW (formerly Weight Watchers) members (N = 18,769, 94.6% female, 91.1% white) completed an online survey from 2017 to 2018. Participants reported whether they had experienced weight stigma and, if so, the onset, past-year frequency and distress, and interpersonal sources of stigma. Participants completed the Modified Weight Bias Internalization Scale (WBIS-M) and self-reported: past-year weight and lifetime weight cycles; current self-monitoring behaviors; eating self-efficacy; physical activity; perceived stress; eating to cope; body image; and mental and physical health-related quality-of-life (HRQOL). Participants reported their demographic characteristics, including height and weight to compute body mass index.ResultsIn logistic and linear regression analyses (controlling for participant characteristics), WBIS-M scores were negatively associated with weight loss, self-monitoring, eating self-efficacy, body image, and mental HRQOL and positively associated with weight gain, weight cycling, perceived stress, and eating to cope (p < .001). Experiencing weight stigma was associated with greater weight loss and less weight gain, although associations with other variables had small effect sizes (absolute β values < 0.10). WBIS-M scores remained significantly associated with all variables when including stigma onset, frequency/distress, and sources.ConclusionsInternalized, but not experienced, weight stigma was consistently associated with adverse weight and health factors. Developing and testing interventions targeting internalized stigma in the context of weight management should be a research priority.
Project description:BackgroundSelf-management of diabetes is associated with glycaemic control and adherence to medication and healthy lifestyle practices. There is lack of information on the barriers to and facilitators of diabetes self-management practices in low income country, Nepal. This study aimed to explore the barriers to and facilitators of Type 2 diabetes self-management practices taking multiple stakeholders' perspectives in Nepal.MethodsFour focus group discussions and 16 semi-structured interviews with people with Type 2 diabetes, caregivers, health care providers and health managers were conducted from April to May 2018 in Rupandehi district of Western Nepal. They were audio-recorded, transcribed, and analysed using a thematic approach.ResultsFive main themes emerged that influenced diabetes self-management practices: individual factors, socio-cultural and economic factors, health system and policy factors, availability and accessibility of resources, and environmental factors. The important barriers were: lack of knowledge about diabetes self-management practices, cultural practices, insufficient counselling, lack of guidelines and protocols for counselling, and financial problems. The major facilitators were: motivation; support from family, peers, and doctors; and availability of resources in the community.ConclusionBased on our findings, a multilevel approach is needed to address these barriers and facilitators. These findings will help guide strategies to develop programs that impart knowledge and skills to improve the diabetes self-management practices of people with Type 2 diabetes.
Project description:Epilepsy self-management practices enhance a patient's competence and confidence in managing their chronic condition, which is assumed to lead to an improved quality of life (QoL). We analyzed the relationship between the Epilepsy Self-Management Scale (ESMS) responses and the Quality of Life in Epilepsy (QOLIE-31) scores. Baseline questionnaires from HOBSCOTCH, a self-management program for cognitive problems, were administered in four New England epilepsy centers on adults (n = 100) with epilepsy and subjective memory complaints. There was no correlation between overall self-management scores and overall quality-of-life scores; however, subscale analyses indicated that certain self-management practices were strongly correlated with the overall QOLIE-31 score. Specifically, improved ESMS lifestyle management was associated with an increased quality-of-life score (adjusted p < 0.01), while enhanced ESMS safety management practices were associated with a decreased overall quality-of-life score (adjusted p < 0.01). Our item-level analysis highlighted specific items within the ESMS safety management, ESMS lifestyle management, and ESMS information management subdomains that were significant predictors for QoL. Depression was also shown to be significantly correlated with the QOLIE-31 (p < 0.01). Our study suggests that an overemphasis on safety practices may negatively affect quality of life, while enhanced lifestyle management has positive effects. Furthermore, our finding that quality of life is greatly dependent on depressive symptoms underscores the importance of treating depression in epilepsy.
Project description:BackgroundThe COVID-19 crisis is likely to have had wide-ranging consequences on lifestyle behaviours and may have affected weight management. The objective of the present study was to examine perceptions of how weight-related lifestyle changed in social lockdown among UK adults compared with before the emergence of the COVID-19 crisis.MethodsAs part of an online cross-sectional survey conducted during social lockdown in the United Kingdom, 723 UK adults reported on the extent to which their eating (healthiness of diet, frequency of bingeing on food), physical activity, sleep and alcohol consumption had changed since the emergence of the COVID-19 crisis and completed measures of current psychological well-being.ResultsAlthough both improvements and declines in weight gain protective behaviours were reported, 79% of participants reported a decline in one or more weight gain protective behaviours. Both participants with a diagnosis of psychiatric illness or obesity (body mass index [BMI] ≥ 30) were most likely to report declines in weight gain protective behaviours and show an overall profile of weight management behaviours worsening. Participants experiencing high levels of stress also reported reductions in more weight gain protective behaviours.ConclusionsLifestyle behaviours associated with weight gain are likely to have been affected by the COVID-19 crisis. Reductions to the perceived frequency by which people engage in behaviours usually associated with successful weight management appear to be common, and people living with obesity and mental health problems may be at increased risk.
Project description:BackgroundNHS England has recommended a multidisciplinary weight management services (MWMS-Tier 3 services) for patients requiring specialized management of obesity, including bariatric surgery, but clinical and measurable health-related outcomes from these services remains fragmented. We therefore undertook a systematic review to explore the evidence base of effect on body weight loss and comorbidities outcomes of Tier 3 or UK pre-bariatric MWMPs.MethodsAMED, CINAHL, EMBASE, HMIC, MEDLINE, PsycINFO, PubMed, HDAS search and Google Scholar were searched from January 2000 to September 2017 in a free-text fashion and crossed-references of included studies to identify potential illegibility. Inclusion criteria were as follows: (a) published Tier 3 original study abstracts/articles; (b) intervention studies with before and after data; (c) studies that included any sort of MWMPs conducted on British residents with obesity; and (d) studies included T2DM measurements in a MWMPs.ResultsIn total, 19 studies met the inclusion criteria. The total number of participants analysed was N = 11,735. Baseline accumulative average BMI was calculated at 42.54 kg/m2, weight 117.88 kg and waist circumference 126.9 cm. And at 6 months, 40.73 kg/m2, 112.17 kg and 120.3 cm, respectively. Secondary outcome variables were as improved with reduction in HbA1c, fasting blood sugars, insulin usage and blood pressure. Physical activity increased at 3 months then declined after 6 months with no significant changes in cholesterol levels.ConclusionTier 3 and MWMPs have a short to mid-ranged positive effect on obese patients (BMI ≥30 kg/m2) living in the UK regarding accumulated reduction in weight, glycaemic control, blood pressure and with subtle improvements in physical activity.
Project description:BackgroundIn response to COVID-19 there have been lockdowns and restrictions to hospitality services. Drinking behaviours often change in response to traumatic events and changes in the drinking environment, and this is influenced by a range of factors. This study explores self-reported changes in alcohol consumption in the third month of the UK lockdown, associations with socio-demographics factors and with COVID-19-related concerns, and mental health and wellbeing.MethodsThe COVID-19 Psychological Wellbeing Study was a longitudinal, online, three-wave survey of 1958 UK adults. Data were collected during the first UK lockdown; wave 1 launched 23 March 2020, wave 2 was 1 month after and wave 3 2 months after completion of wave 1A hierarchical multinomial regression model was estimated to investigate factors associated with changes in perceived alcohol consumption in the third month of the lockdown.ResultsThe majority of participants reported changes in drinking (62%) with over one-third indicating increased consumption. Student status and worries about the financial implications of COVID-19 were associated with lower odds of decreased alcohol consumption. Those with above average income and those with children in the household had lower odds of increased alcohol consumption, while younger adults had higher odds of increased alcohol consumption.ConclusionsThis study adds to the growing body of research showing changes in alcohol consumption behaviours during the COVID-19 lockdown restrictions, and identifies risk and protective factors which can aid in targeting intervention at those most in need of support.